Project Summary/Abstract Mentally ill persons involved in the criminal justice system represent the new frontier for community mental health and disability research. The scope of this problem is truly staggering with upwards of 86,000 persons with severe mental illness (SMI) released from prisons each year with high rates of recidivism. The loss of Medicaid benefits by incarcerated offenders is thought to be a major obstacle to successful community reentry. Several states have adopted expedited Medicaid restoration programs to reconnect eligible prisoners to their benefits prior to release. Early benefit restoration can avoid disruptions in medication regimens and treatments for offenders with SMI when they are released to the community. However, no rigorous research has been conducted to establish the cost-effectiveness of these policies. The proposed responds to with RFA-MH-09-050 from the NIMH with a three-year study that addresses these concerns by undertaking an assessment of Medicaid restoration policies in Connecticut and Washington State for released prisoners who have SMI with regard to three outcomes-subsequent recidivism, hospitalizations, and outpatient mental health and substance abuse service use. Two complementary study designs and analytic approaches will be implemented to address the impact (Aim 1) and cost-effectiveness (Aim 2) of these policies. The first is a difference-in-difference design comparing individuals with SMI and those without SMI centered on a policy adoption date of April 1, 2005 in Connecticut and January 1, 2006 in Washington with three years pre and two years post data in each state. The second is a quasi-experimental study design focused on the post-period only comparing individuals with SMI who received expedited Medicaid restoration (treatment group) vs. those who did not (comparison group) over a two-year follow-up period using a hierarchical linear modeling framework. Propensity score matching will be used with both designs to achieve balance between groups on all observed measures. The proposed study is well-aligned with RFA-MH-09-050 in that it addresses an important mental health policy issue for state authorities, takes advantage of a wealth of administrative data from two states, applies an array of analytical strategies from the fields of economics and statistics to address an important state mental health policy issue, and responds to the call for research about justice-involved persons with severe mental illness as put forth in the President's New Freedom Commission on Mental Health (2002). PUBLIC HEALTH RELEVANCE: All across the US mentally ill offenders are returning to their home communities. Research needs to identify their needs and how they can successfully reintegrated into community life without further criminal justice involvements. This proposal is addressed to this major public health problem.